Long-term course and outcome in panic disorder: a naturalistic follow-up study.

Fifty-five of 102 consecutively evaluated patients with panic disorder seen in consultation at a specialty anxiety and mood disorders clinic were reinterviewed from 15 to 60 months later after naturalistic treatment in the community. Over the follow-up period, most patients displayed improvement in panic attack frequency and severity, phobic avoidance, depression, and major role functioning, although only five (10%) were asymptomatic on all measures at follow-up. The majority of patients with impaired interpersonal functioning showed no improvement on this measure. Thirty percent of the patients were panic-free at 12 months and 28% at the time of follow-up, with 43% experiencing at least three panic-free months during the follow-up period. Comorbid agoraphobia, major depression, and Axis II disorders were associated with worse outcome on selected measures of symptomatic and functional impairment. However, the strongest predictors of overall improvement were avoidance coping for outcome at 12 months and Axis I comorbidity for outcome at the time of the follow-up evaluation.